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General NPI Number Information
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NPI Number | 1609281534
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Entity Type | Individual
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Provider Name | RYAN HUNTSMAN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 5125 SKYLINE RD S
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City | SALEM
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State | OR
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Zip | 97306-9413
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Country | US
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Telephone | 855-248-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 544 W HILL ST
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City | THOMSON
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State | GA
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Zip | 30824-2117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001532
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36.003811
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DP217875
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License Number State | OR
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